Connections with nature for people living with dementia – new article around green dementia care

We’ve recently had an article published in the Working with Older People journal relating to a project we carried out with the Housing and Dementia Research Consortium (HDRC) around green dementia care. Although the article provides a lot more information, we thought we’d give you an overview here, especially as not everyone knows much about green dementia care.

Housing and Dementia Research Consortium logo

What is green dementia care?

Green dementia care, or nature-based dementia care, refers to indoor and outdoor experiences and activities that aim to promote health and wellbeing through interaction with nature for people living with dementia. However, many people living with dementia in care homes or extra care housing have limited opportunities to connect with the natural world, often due to organisational concerns about safety and security and outdoor spaces that are not fully accessible.

Residents living with dementia are often discouraged from going outdoors, meaning that they can quickly lose confidence to go outdoors with or without support. This puts them at risk of losing their personal connection to nature and the benefits that engaging with nature may bring to their health and wellbeing.

What was the research trying to find out?

The Association for Dementia Studies and the HDRC received funding from The Abbeyfield Research Foundation to carry out a pilot study on ‘Nature-based dementia care in accommodation and care settings’. It aimed to explore the opportunities, good practice, enablers and barriers relating to nature-based dementia care for people living with dementia in care homes and extra care housing schemes or villages.

What did we do?

Four key activities were carried out during the study:

  • Literature review – to explore existing evidence relating to nature and dementia;
  • Online survey – to identify what is currently taking place to help people with dementia in accommodation and care settings to experience nature;
  • Interviews with residents with dementia at six case study sites – to understand the benefits, barriers and enablers to interacting with nature;
  • Interviews with managers and staff at six case study sites – to understand staff perceptions of the enablers and barriers to engaging with nature, and also the challenges and successes.

What were the findings?

Residents with dementia

“You feel a bit more freedom than when I’m in here”

Engaging with nature can have a range of mental and emotional benefits for residents with dementia, offering a feeling or normality, peace and wellbeing, but also a feeling of freedom and a change of environment.

“I’m not an inside person. That’s where I like to be”

It helps residents to feel happier, more settled, relaxed, less stressed and raises spirits. Engaging with nature can also provide meaningful occupation and a sense of purpose, although there can be a potential negative impact if residents discover they are no longer able to carry out activities they used to enjoy.

“I’m always out there. I do a little bit of tidying up. I’m not asked to, but I just mess about, keep myself busy”

There can also be social benefits by encouraging more interaction and participation, and conversations can be started when memories are triggered. Behaviour can also be improved by residents being busier, more motivated and more alert, while physical health and wellbeing also feels the benefit of nature-based activities. Residents can improve their core strength and balance which may help to reduce falls, while motor skills can also benefit from regular activity. Improvements were also noted for eating and drinking as activities were helping to stimulate appetites.

Family members

Seeing residents engaging in nature-based activities they enjoy can bring pleasure to family members, which in turn improves their emotional wellbeing and quality of life. The activities can also provide a focus that helps family members engage and communicate with residents, giving them a joint activity that they can do or talk about together.

Staff

Being involved in nature-based activities also has a positive impact on staff, improving morale, job satisfaction and confidence amongst other things.

“It’s my little bit of respite as well from the day job. It’s me keeping my sanity as well as theirs.”

Barriers

Many barriers to the provision of nature-based activities were identified during the study, including risk aversion, the availability of staff and volunteers, time and financial constraints, negative attitudes towards such activities, organisational policies, and the size and design of outdoor spaces. Barriers for individual residents were also found, relating to personal preferences, lack of confidence or belief in their own ability, and fear of aggravating a physical condition.

So what can we do?

A crucial factor in the successful use of a care setting’s outdoor space is an underlying care culture that is person-centred, promotes residents’ independence, has a positive attitude towards risk-taking, and is supportive of residents going outdoors. If we consider the main elements underpinning the provision of successful nature-based dementia care, the following diagram provides a visual representation.

Recommendations from the project

For further information about this study, please see the published article or contact the HDRC Research Coordinator Dr Julie Barrett (j.barrett@worc.ac.uk).

Evans, S.C., Barrett, J., Mapes, N., Hennell, J., Atkinson, T., Bray, J., Garabedian, C. & Russell, C. (2019). Connections with nature for people living with dementia. Working with Older People.

Connect with the HDRC on twitter @HousingDementia

Connect with ADS on twitter @DementiaStudies and on Facebook @adsuow

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